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Benfeciary Public Building Template -Form Fill
Information
Q01
Name of the LG
Q02
Code
Q03
Name of the Project / asset
Q04
Code
Q05
Year of the Project
Q06
Project / asset UID
Q07
Date of Interview
Q08
Time of interview
Q09
Interviewer
Q10
Code
Q11
Respondent’s eligibility Assessment
Q12
What is your age?
Q13
Do you use the services of the Grama Panchayat and Municipality office (Specify form the list)?
Yes
No
Q14
Are you a usual resident of this Grama Panchayat / municipality?
Yes
No
Q15
How long you have been staying in this Grama Panchayat?
Q16
How familiar you are with your GP/ municipality activities or initiatives?
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Extremely familiar
Demographic information (Common to all)
A01
Name of the Respondent
A02
UID of the respondent
A03
Gender of the respondent
Male
Female
Other gender
A04
What is your marital status?
Married
Unmarried
Widow / Widower
Divorced
Separated
Deserted
A05
Address of the Respondent
A06
What is your religion?
Hindu
Muslim
Christian
Sikh
Budhist / Neo Budhist
Jains
Jews
Parsi / Zorastrian
No religion
Others (Specify……..)
A07
What is your caste category or community category?
SC
ST
OBC
General
No caste
OEC
Others Specify
A08
What is the highest educational qualification you completed?
Never attended school
Primary(1-5)
Upper Primary (6-8)
Secondary (9-10)
Higher / Senior Secondary (11-12)
DIPLOMA/CERTIFICATE COURSE (BELOW GRADUATE LEVEL)
GRADUATE
POSTGRADUATE AND ABOVE,
A09
What is your profession or key sources of income?
A10
Does your family belong to APL or BPL category?
APL
BPL
Don’t Know
A11
Land availability
A11A
Units
Acres
Hectare
Cent
Others (Specify)
A12
Please determine respondent is the key beneficiary of which of the following sectors and skip to related sector
Agriculture – (Krishi Bhavan / Farm Mechanization)
Anganwadis
Animal Husbandry – Veterinary hospital
Arts, Culture and sports development, Youth welfare: Playground / Art gallery / Samskarika Nilayam
Computerisation – for panchayat office / Transferred institutions /Schools
Drinking water
Education -School building
Electric line, Transformer
Energy generation/ Energy protection – Solar street lights
Street light, Office electrification: Street lights, High mast lighting, Office electrification
Health – Hospitals (PHC, CHC)
Housing, House Electrification
Irrigation – Minor or micro irrigation projects
Other construction works
Soil-water conservation, Environment, afforestation
Public Buildings which are not included in productive and service sectors - GP/MC office, GP/MC front office, GP/MC community hall / Auditorium,
Reading Rooms, Libraries and Grama sabha /ward sabha centres
Sanitation, Waste processing: Drainage / Toilets/ bathing places / solid waste management / crematoriums
Social welfare, social security
Transport (Road /culvert/small bridges/foot paths/side walls/path ways-construction, renovation, maintenance)
Public Buildings which are not included in productive and service sectors - GP/MC office, GP/MC front office, GP/MC community hall / Auditorium
Respondent backgrounds
B01
Do you or any of your house hold members use the services of this GP/MC office, GP/MC front office, GP/MC community hall / Auditorium ?
Yes
No
B02
How far this GP/MC office, GP/MC front office, GP/MC community hall / Auditorium, is from your house hold?
B03
When did you last visited GP/MC office, GP/MC front office, GP/MC community hall / Auditorium ?
B04
What was the purpose of your last visit to GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
B05
Project / Asset Planning
B06
Do you think constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium area was very much needed?
Yes
No
B07
If so, please why it is much needed or not needed? Please elaborate
B08
Did GP /Municipality officials consult residents / staff of this ward or in this area before constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B09
Do you know whether the Panchayat / Grama /wards Sabha has discussed the need / requirement of this project in any of its meeting before constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B10
What kind of suggestions residents or panchayat members or officials / grama /ward sabha members has given?
B11
What is the compliance to the suggestions given?
Suggestion accepted but, not implemented
Suggestion accepted and implemented
Suggestion not accepted
B12
Project / Asset Implementation
B13
Approximately how long ago construction /maintenance / renovation of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium was completed and this was ready for public use?
B14
Did the Engineers or Officials from GP/Municipality has supervised the construction /maintenance / renovation of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B15
Did the local elected representative involved themselves during the construction /maintenance / renovation of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium ?
Yes
No
B16
Any forest land or sensitive areas were invaded or modified during the constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B17
please elaborate
B18
Any natural resource depleted during the constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B19
please elaborate
B20
Any unreasonable interference caused to the environmental values (air pollution, smoke, sound pollution, water logging, erosions, mud or material stocking) during the constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B21
What kind of remedies were taken to reduce or stop the unreasonable interference to the environment?
B22
Project / Asset Maintenance
B23
How frequently this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium is maintained or repaired by GP/ Municipality?
Less than once six months
Once a year
Once in two year
Other (specify…………..)
Don’t know
B24
When was this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium was maintained or repaired by GP/ Municipality last time?
B25
Use and Utility
B26
How often do you utilize the services from this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Every day
Alternative days
Weekly twice
Weekly
Once in 15 days
Once in a month
Others (Specify ………………………………………)
B27
When was the last time you utilized the services from this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Today
Yesterday
In present week
In last week
Others (Specify ………………………………………)
B28
What kind of services do you or your house hold receive from this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Building construction license
Licenses for setting up commercial buildings / production units
Licenses to dangerous and offensive trades
Registration of birth and deaths
Certificates – Caste / APL-BPL/ Income / Domicile
Ration card / VoteR Card / Aadhar Card services
Approval for public celebrations / Rally’s / Loud speakers / Processions
Subsidies
NREGEA related services
Avail drinking water / Street light/ transport / sanitation related services
Pension schemes
Others (Specify ………………………………………)
B29
What are the benefits or advantages of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
One point approach at front office
Less time consumption
Adequate staff
Adequate infrastructure such as computers / Printers/ Photocopy machine / Stationeries
Need not to approach multiple officers
Comforts at reception areas such as seating / TV/ Drinking water/Toilets/Fan
No confusions
Fast services
Need not to visit multiple times
Need not to follow-up again and again
Clear display of services and schemes
Others (Specify ………………………………………)
B30
What are the dis advantages or drawback of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Poor staffing
Poor infrastructure such as computers / Printers/ stationery
Not well furniture for staff or beneficiary
Less /no place to sit or wait
Drinking water / Toilets are not available
No special attention
Need to walk around
Repeated follow-ups and reminders
Slow services or time consumption
Others (Specify ………………………………………)
B31
How beneficial do you think this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Very Beneficial
Beneficial
Average
A little beneficial
Not at all beneficial
B32
How satisfied you are with the benefits or services you have received from this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Very satisfied
Satisfied
Neither satisfied nor unsatisfied
Partially satisfied
Not at all satisfied
B33
Provide details on your satisfaction level.
B34
How beneficial do you think this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium has been for the residents of this ward or in this area?
Very Beneficial
Beneficial
Average
A little beneficial
Not at all beneficial
B35
Do you think there are changes in the life of the residents of this ward or in this area due to this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes, there is considerable changes
Yes, but minor improvements
No changes, it is same
B36
Please elaborate the changes in life of residents of this ward or in this area due to this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
B37
Quality of the asset or Infrastructure
B38
How would you rate the aesthetic view of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Very Good
Good
Average
Below Average
Poor
B39
How would you rate the infrastructure quality of this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Very Good
Good
Average
Below Average
Poor
B40
Does the GP / MC office has followings?
B40_1
Own building
Yes
No
B40_2
Adequate office space
Yes
No
B40_3
Adequate office staff
Yes
No
B40_4
Meeting hall / Conference hall
Yes
No
B40_5
Front office
Yes
No
B40_6
Adequate front office staff
Yes
No
B40_7
Toilet facilities
Yes
No
B40_8
Waiting ares with seating arrangments
Yes
No
B40_9
Fan in waiting ares
Yes
No
B40_10
Drinking water in wating ares
Yes
No
B40_11
Computers
Yes
No
B40_12
Electricity supply
Yes
No
B40_13
Adequate furniture
Yes
No
B40A
Does the community hall / Auditorium has followings?
B40A_1
Adequate space for meetings and conference
Yes
No
B40A_2
Separate toilets for men and women
Yes
No
B40A_3
Utility are
Yes
No
B40A_4
Adequate staff for maintenance
Yes
No
B40A_5
Electricity supply
Yes
No
B41
GP / Municipality service delivery (Improvements in quality)
B42
What are the different infrastructure / facilities provided by GP / municipality to improve the services in the GP / Municipality office?
B43
Do you think there are improvements in the quality of infrastructure / facilities provided by GP / municipality to improve the services in the GP / Municipality office?
Yes
No
B44
How would you rate the quality of infrastructure / facilities provided by GP / municipality to improve the services in the GP / Municipality office?
Very Good
Good
Average
Below Average
Poor
B45
How satisfied you are with the quality of infrastructure / facilities provided by GP / municipality to improve the services in the GP / Municipality office?
Very satisfied
Satisfied
Neither satisfied nor unsatisfied
Partially satisfied
Not at all satisfied
B46
Have you utilized the services of GP/Municipality before constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Yes
No
B47
If yes or no, please elaborate
B48
What was the situation before creating the…… (name of the focal project)?
B49
How would you rate the quality of services of GP/Municipality before constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Very Good
Good
Average
Below Average
Poor
B50
How often did you utilize the services of GP/Municipality before constructing /maintaining / renovating this (focal project) GP/MC office, GP/MC front office, GP/MC community hall / Auditorium?
Every day
Weekly Once
Once in 15 days 15
Once in a month
Others (specify)
B51
Do you think GP /Municipality has provided adequate infrastructure facilities for providing services at GP/Municipality office as per the needs of the locality?
Yes, adequate facilities are given (Please elaborate….)
Yes, but need improvements (Please elaborate….)
No, adequate facilities are not provided (Please elaborate…….)
B52
Would you like to say anything about this GP/MC office, GP/MC front office, GP/MC community hall / Auditorium which we haven’t discussed so far?
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